Purpose: To describe the prevalence and causes of low vision and blindness in a rural population in Northern China. Design: Population-based, cross-sectional study. Participants: A study of 6830 Han Chinese aged 30 years and older was conducted between October 2006 and October 2007 in rural Yongnian County in Handan, Northern China. Methods: Clustered samples of adults aged 30 years or more residing in 13 residential villages were selected randomly and were invited to participate the Handan Eye Study. Participants underwent a comprehensive eye examination, including standardized visual acuity (VA) tests using logarithm of the minimum angle resolution charts. Prevalence was age- and gender-standardized to the 2000 China Census. Main Outcome Measures: Low vision was defined as VA <20/60 but >= 20/400, and blindness was defined as VA <20/400 following the Modified World Health Organization (WHO) definitions. Primary causes of low vision and blindness were determined by study ophthalmologists according to WHO definitions. Results: Six thousand eight hundred thirty (90.4%) of 7577 eligible individuals participated in the study, and 6799 (89.7%) had VA data available. Population-weighted prevalence of presenting bilateral blindness was 0.6% and bilateral low vision was 4.7% for persons 30 years of age and older. Based on best-corrected visual acuity (BCVA), the corresponding prevalence of blindness was 0.5% and that of low vision was 1.0%. Blindness and low vision were strongly age related (P<0.05). Cataract was the predominant cause of presenting bilateral blindness (36.6%), whereas undercorrected refractive error was the predominant cause of presenting low vision (78.4%). After refractive correction, cataract became the first leading cause of blindness (41.9%), and low vision (48.2%), myopic retinopathy (16.1%), glaucoma (9.7%), and corneal opacity (9.7%) were other common causes of blindness defined using BCVA. Conclusions: A higher prevalence of blindness and low vision was seen in this rural Chinese sample than has been reported from urban Chinese populations. The estimated numbers with BCVA-defined low vision and blindness in 2020, based on best-corrected vision in rural Chinese adults aged 30 years or more, is expected to be 12.4 million and 2.9 million, respectively. Predominant causes of low vision and blindness in China are treatable. Financial Disclosure(s): The authors have no proprietary or commercial interest in any materials discussed in this article. Ophthalmology 2008;115:1965-1972 (C) 2008 by the American Academy of Ophthalmology.